Abstract：
This is a case of a woman in her 50s with HIV and uncontrolled diabetes who presented to the emergency department with urinary retention and a painful gluteal cleft lesion, admitted for cellulitis. Since initial CT and soft tissue ultrasound (US) were negative for fluid collection, the care team was surprised to find her symptoms continued to progress despite intravenous antibiotics. Finally, MRI 9 days into her admission demonstrated a 12-cm perirectal horseshoe abscess. The patient was ultimately treated with incision and drainage with Penrose drain placement. This case demonstrates the importance of maintaining a high suspicion for horseshoe abscess, a complex form of ischiorectal fossa abscess which can be missed on CT and US imaging, and which may expand rapidly in immunosuppressed patients.
摘要：
这是一个50多岁的妇女患有艾滋病毒和不受控制的糖尿病，她因尿潴留和臀裂病变疼痛而出现在急诊科，因为蜂窝织炎而入院.由于最初的CT和软组织超声（US）对液体收集呈阴性，护理团队惊讶地发现，尽管静脉注射抗生素，她的症状仍在继续进展。最后,入院9天的MRI显示直肠周围12厘米的马蹄形脓肿。患者最终接受了Penrose引流管的切开引流治疗。这个案例显示了对马蹄形脓肿保持高度怀疑的重要性，一种复杂形式的坐骨直肠窝脓肿，可以在CT和US成像中遗漏，在免疫抑制患者中可能迅速扩张。
